Aesthetic Improvements of Skin Grafts in Nasal Tip Reconstruction

Abstract

Defect closure on the nasal tip subunit still remains challenging. Full-thickness skin transplantation still is used despite its poor outcome in terms of the nasal tip contour caused by lack of dermal tissue. To avoid subsidence deformities associated with nasal tip reconstruction with skin transplants, this study analyzed methods using combined epidermal and dermal replacement. For 30 consecutive patients with a nasal tip defect, a retrospective comparison was made between conventional full-thickness skin transplantation, retroauricular perichondrodermal composite grafts, and skin transplantation supplemented with the collagen-elastin matrix, Matriderm, used as a dermal substitute (n = 10 per study group).The postoperative results were evaluated in a randomized and blind manner by external facial surgeons using the Manchester Scar Scale. The findings showed a marked improvement in nasal tip contour with combined epidermal/dermal replacement without any deterioration in other graft qualities, justifying the additional effort involved in this procedure. Two patients developed fistulae after Matriderm-aided skin transplantation. Therefore, the authors do not consider this a suitable method for nasal tip reconstruction.

Skin cancers and dermal substitutes: Is it safe? Review of the literature and presentation of a 2‐stage surgical protocol for the treatment of non‐melanoma skin cancers of the head in fragile patients

“…We performed the first review of the literature about studies that describe dermal substitutes’ utilisation in reconstruction after skin tumour excision. Table enlists publications available until July 2017 …”

“…NMSC present quite high recurrences' rates, and we evaluated their incidence in the studies reviewed. Of them, 25 did not report data about recurrence or did not provide the complete text in English in order to evaluate this aspect . Eleven studies showed no recurrences among their patients, while 6 articles reported cases of recurrence that ranged from 5% to 25% …”

One-stage reconstruction of soft tissue defects with the sandwich technique: Collagen-elastin dermal template and skin grafts

“…In a comparative study, Riml et al . [23] observed better outcome with a perichondrodermal composite graft and reported two patients developing fistulae after Matriderm ™ -aided skin transplantation. [23] We observed a complete graft take in three of four patients, but further studies are necessary.…”

Analysis of reconstructive methods in surgical treatment of nasal skin defects

“…Singh and Bartlett 20 modify the nasal subunit principle taking into account local characteristics such as skin color, texture, contour, and actinic damage. Esthetic considerations, such as skin texture, color, and contour, used in the resurfacing of skin defects have been chronicled in the evolution of nasal reconstruction 21 . Skin color, texture and contour play a critical role in final determination of the reconstruction type 22 .…”